Healthcare Provider Details

I. General information

NPI: 1518379205
Provider Name (Legal Business Name): IPS ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 GEMINI PL STE 301
COLUMBUS OH
43240-6112
US

IV. Provider business mailing address

1210 GEMINI PL STE 301
COLUMBUS OH
43240-6112
US

V. Phone/Fax

Practice location:
  • Phone: 614-987-7603
  • Fax: 614-987-7614
Mailing address:
  • Phone: 614-987-7603
  • Fax: 614-987-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1097AS
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: EDWARD J KOWLOWITZ
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 317-706-7246